PICC care and education

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Intravenous literature: Leung, T.K., Lee, C.M., Tai, C.J., Liang, Y.L. and Lin, C.C. (2011) A retrospective study on the long-term placement of peripherally inserted central catheters and the importance of nursing care and education. Cancer Nursing. 34(1), p.E25-30.

Abstract:

BACKGROUND: Peripherally inserted central catheters (PICCs) have been used for years in Taiwan, but their broad usage has been restricted by their short durability and complications.

OBJECTIVE: The aim of this study was to evaluate the most important factors causing failure of PICCs by comparing 2 periods of retrospectively studied cases before and after we implemented nursing care improvements.

METHODS: We analyzed possible factors affecting the length of the insertion period, according to the reasons for catheter withdrawal after insertion, self-care ability, coagulation status, and other factors. We reviewed 2 different periods of PICC insertions at our hospital (133 and 143 cases, respectively) before and after an announcement of nursing educational comprehensive guidelines for post-PICC care.

RESULTS: In the first period, the most common complication due to PICC placement was wound oozing (24.7%), followed by infection/phlebitis (9.7%), occlusion (6.7%), and leaking (3.8%). In the second period, comprehensive educational guidelines for post-PICC manipulation were provided. The outcomes of PICC insertions significantly improved from 33.8% in the first period to 64.3% in the second period (odds ratio, 3.53), and the complication rates of persistent oozing (7%), infection (4.2%), and occlusion (2.8%) significantly decreased.

CONCLUSIONS: Changes in nursing care provided in the period 2 contributed to improvements in the success rate of PICC.

IMPLICATIONS FOR PRACTICE: This is the first study suggesting that cancer nursing practice for PICC could benefit from professional guidelines that reinforce in-service education, strict control of PICC candidates without risk of coagulopathies, and a special nursing care system for patients with poor self-care ability.

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